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What is Acne

What is AcneAcne Vulgaris (or acne) is a skin disease that can affect people at one time or another during their lives. Typical types of acne include: seborrheoiac (scaly red skin), comedonal (blackheads and whiteheads),  papules (pinheads), pustules  (pimples) and nodules (large papules).  All acne can result in scarring, however in darker skin scarring can be more prevalent.

Acne most often affects areas of the skin densely populated with sebaceous follicles; including the face, upper part of the chest and back. Severe acne is inflammatory, however acne can also manifest in non-inflammatory forms.

All forms of acne are caused by changes in pilosebaceous units - skin structures consisting of a hair follicle and its associated sebaceous gland.

Acne generally occurs during adolescence, often continuing into young-adulthood. An increase in testosterone (which accrues in both genders during puberty) is the most common cause.

For many people, acne diminishes over time, tending to disappear completely (or at the very least decrease substantially) around our early 20s.  However some will experience acne well into their 30’s and 40’s and can in fact develop acne well into adulthood.

Larger nodules are known as cysts whilst the term nodulocystic has been used to describe severe cases of inflammatory acne.  Cysts generally appear on the buttocks, groin or armpit area but can occur anywhere that sweat collects in hair follicles and perspiration ducts.  Cystic acne affects the deeper layer of skin tissue more profoundly than common acne.

Aside from scarring, the main effects of cysts or nodulocystic acne tend to be psychological and can result in reduced self-esteem and depression.  Acne usually appears during adolescence, when teens already tend to be at their most socially insecure. Early and intensive treatment is therefore advocated to lessen the emotional and physical impacts of acne. Topical skin care is only one part of the treatment process.

Effective treatments for acne are very different depending on whether the acne is a dry acne (acne tarda), or a wet/oily acne. All too often people think all acne is produced from oily skin, however, many cases of acne are actually caused by the skin being ‘dried out’.  Sadly, this is generally caused by the inappropriate use of cosmetics for the true skin type.  When the natural lipidic balance of the skin is out of shape, the skin produces an over-abundance of sebum.  Simple mistakes such as this can send the sebaceous glands into overdrive, which can result in acne.

Grades of Acne

Acne is classified into four grades according to severity. Specific criteria are used to classify acne symptoms, including:

  • types of non-inflamed comedones present
  • types of inflamed comedones present
  • amount of breakout activity
  • amount of inflammation,
  • areas of the body affected by acne

Assessing the grade of acne by a trained skin treatment therapist or dermatologist/ doctor is an important step in treatment, as all acne grades require different treatment methods.  Only trained therapists, dermatologists and/or doctors can advise in this regard.

Grade I

Appearance:  The mildest form of acne. There may be minor pimples but they will be small, appear only very occasionally, and in few numbers. Comedones (blackheads) and Milia will be found, sometimes in great numbers, but there is no inflammation present in this grade of acne.

Grade I acne is commonly seen in early adolescence, especially on the nose and/or forehead. Many adults also experience grade I acne, as blackheads on the nose and forehead. Milia are commonly found around the eye area and chin.

Grade I acne may progress to Grade II if left untreated.

Suggested treatment: tailored facial treatments supported by customised skin care designed for your skin type.

Grade II

Grade 2 AcneAppearance:  Blackheads and Milia exist, generally in greater numbers. Papules and Pustules become more evident in this stage. They will appear with greater frequency, and general breakout activity will be more obvious. Slight inflammation of the skin is now apparent.

In teens, acne may progress from the nose and forehead to other areas of the face.  Acne may start to affect the chest and shoulders, with occasional breakouts on the back, especially in males. Adult women may find greater breakout activity on the cheeks, chin and jaw line area, especially just before and during the menstrual cycle.

Grade II acne may progress to Grade III, especially if pimples are habitually picked at or squeezed, as these habits cause the acne to spread.

Suggested treatment:  More serious skin treatments with a specialised acne focus will be necessary. Pay careful attention to the ingredients/ types of facials as products and treatments range from potentially harmful Benzoyl Peroxide and other ingredients that can unnecessarily peel the skin  ,through to the pure and active products found in the  in the dermaviduals range. Many ‘over-the-counter’ products contain the ingredient Benzoyl Peroxide . Please carefully consider using these products as research indicates increased sensitivity to sunlight and allergies reactions to it. Whilst these ingredients can lead to short term fixes in the skin, often longer term problems can be created.

Grade III

Grade 3 AcneAppearance: Considered severe, the main difference between Grade II acne and Grade III is the amount of inflammation present. The skin is now reddened and inflamed. Papules and pustules have developed in greater numbers, and nodules will be present.

Grade III usually involves other body areas, such as the neck, chest, shoulders, and/or upper back and face. The chance of scarring becomes higher as the infection spreads and becomes deeper.

Suggested treatment: Only a qualified dermatologist or specialist skin treatment therapist should treat acne at this stage. Grade III acne is usually treated with both topical and systemic therapies available only by prescription. Left untreated, Grade III acne may progress to Grade IV.

Grade IV

Grade 4 AcneAppearance: This most serious form of acne is referred to as nodulocystic or cystic acne. The skin will display numerous papules, pustules, and nodules, in addition to cysts. There is a pronounced amount of inflammation and breakouts are severe. Cystic acne is very painful.

Acne of this severity usually extends beyond the face, and may affect the entire back, chest, shoulders, and upper arms. The infection is deep and widespread. Nearly all cystic acne sufferers develop scarring.

Suggested treatment:  Grade IV acne should be treated by a dermatologist in conjunction with your skin care therapist. It tends to be hard to control, and almost always requires powerful systemic medications in addition to topical treatments.

Aggravating Factors of Acne 

Blocked or compromised follicles

Acne develops as a result of blockages in hair follicles. Hyper-keratinisation and the formation of a plug of keratin and an increase in sebum production (a microcomedo so small it is not visible to the naked eye) is the earliest symptom.

Enlargement of sebaceous glands and an increase in sebum production also occur with increased androgen (DHEA-S) production at puberty. The microcomedo may enlarge to form an open comedone (blackhead) or closed comedone (milia). Comedones are the direct result of sebaceous glands becoming clogged with sebum, a naturally occurring oil, and the accumulation of dead skin cells. In these conditions, naturally occurring Propionibacterium acnes (P. acnes) can cause inflammation, leading to lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedone, which results in redness and can result in scarring or hyperpigmentation.

Comedogenic substances

P. acnes are found naturally within our skin and produce a series of fatty acids with potentially comedogenic effects. { Definition: Believed to cause comedones, or pore blockages}. Additional substances that can contribute to acne are mineral oils (oil acne), tar (tar acne), chlorinated hydrocarbons (chloracne), drugs (acne medicamenta) and a multitude of cosmetic substances such as lanolin, cetyl alcohol, saturated fatty acids and their esters.

Those with sensitive skin should avoid ingredients such as ethoxilated alcohols and polyethylene glycols (PEG’s) as both are used as emulsifiers and solubilisers. With the influence of ultraviolet rays and atmospheric oxygen they develop peroxides which in turn generate aggressive radicals which can cause Majorca Acne.

Given these substances are widely used in many cosmetic products, the skin treatment therapist and educated consumer is advised to carefully study the ingredient list on products before prescribing products to treat acne. Even sun protection products can contain these harmful substances. Ethoxilated alcohols can be recognised on the ingredients listing either by their middle or final syllable (-eth), eg. Ceteareth-10.  Please note that no dermaviduals product contains these ingredients.


Hormonal activity, such as menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in male sex hormones called androgens (occurring in both males and females) causes the follicular glands to grow larger and produce more sebum. Use of anabolic steroids may have a similar effect. Several hormones have been linked to the advent of acne in pregnant women and some can lead to disorders such as polycystic ovary syndrome or even the rare Cushing's Syndrome.

Acne associated with menopause occurs as production of the natural anti-acne ovarian hormone Estradiol ceases to be produced at the onset of menopause. The lack of Estradiol can also cause thinning hair, hot flushes, thin skin, wrinkles, vaginal dryness, and can predispose women to osteopenia and osteoporosis, as well as triggering acne (known as Acne Climacterica in this situation).

Development of acne vulgaris in later years is uncommon, although this is the age group where Rosacea can occur. Indications of Rosacea are often confused with acne as they can present with similar symptoms.


The tendency to develop acne can run in families. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions.

While the connection between acne and stress continues to be debated, scientific research indicates that "increased acne severity" is "significantly associated with increased stress levels." The National Institute of Health (USA) lists stress as a factor that "can cause an acne flare." A study of adolescents in Singapore "observed a statistically significant positive correlation between stress levels and severity of acne." Adrenal stress stimulates the body to produce cortisol and adrenalin. These hormones trigger changes in the skin, such as increased oil & sebum production.


Bacteria in the pores, Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne. Resistance of P. acnes to commonly used antibiotics has been increasing.

If you are interested in booking a FREE consultation for advice on the best treatments and products for your acne or acne scarring, please call us today on 0113 282 3300 or complete an enquiry form.